The effect of induction method in twin pregnancies: a secondary analysis for the twin birth study

Elad Mei-Dan,Elizabeth V. Asztalos,Jon F. R. Barrett,Andrew R. Willan

doi:10.1186/s12884-016-1201-8

Elad Mei-Dan, Elizabeth V. Asztalos + Show 2 more

Open Access

https://doi.org/10.1186/s12884-016-1201-8

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Abstract

BackgroundThis secondary analysis for the Twin Birth Study, an international, multicenter trial, aimed to compare the cesarean section rates and safety between methods of induction of labor in twin pregnancies.MethodsWomen with twin pregnancies where the first twin was in a cephalic presentation and who presented for labor induction, were non-randomly assigned to receive prostaglandin or amniotomy and/or oxytocin. Main outcome measures were the rates of unplanned cesarean section and neonatal and maternal mortality or serious morbidity.Results153 (41.5%) were induced by prostaglandin (prostaglandin group) and 215 (58.5%) were induced by amniotomy and/or oxytocin alone (no prostaglandin group). Induction using prostaglandin was more common in countries with a low perinatal mortality rate <10/1000 (45.7 versus 32.5%, p = 0.02). Cesarean section rates were similar in the two groups: 62/153 (40.5%) in the prostaglandin group and 87/215 (40.5%) in the no prostaglandin group (odds ratio 1, 95% CI 0.65-1.5). Nulliparity, late maternal age, non-cephalic presentation of twin B and high country’s perinatal mortality rate were found to be independently associated with the induction to end with an unplanned cesarean section. There were no significant differences between groups with respect to maternal or neonatal adverse outcomes.ConclusionsThe need for cervical ripening by prostaglandin had no effect on the incidence of cesarean delivery or an abnormal outcome. There is a significant risk of unplanned cesarean section independent of chosen induction method.Trial registrationThis trial was registered at the International Standard Randomized Controlled Trial Register (identifier ISRCTN74420086; December 9, 2003) and retrospectively registered at the www.clinicaltrials.gov (identifier NCT 00187369; September 12, 2005).

Highlights

This secondary analysis for the Twin Birth Study, an international, multicenter trial, aimed to compare the cesarean section rates and safety between methods of induction of labor in twin pregnancies
368 women were identified as having undergone induction: 153 (42%) underwent induction with the use of prostaglandin (PG group) and 215 (58%) underwent induction with amniotomy and/or oxytocin, (Fig. 1)
The method of induction of labor had no effect on the rate of cesarean section (CS) for both twins

Summary

Introduction

This secondary analysis for the Twin Birth Study, an international, multicenter trial, aimed to compare the cesarean section rates and safety between methods of induction of labor in twin pregnancies. Twin birth are increasingly common and occur in 2 to 3% of all births [1,2,3] These pregnancies pose an increased risk for adverse perinatal outcomes compared to singletons at all gestations [1, 2]. In attempt to limit these late term losses an elective delivery at 37–39 weeks of gestation has been widely recommended [1, 5,6,7,8] This has led to a marked rise in induction of twin pregnancies from 5.8% in 1989 to 13.8% in 1999, with a concomitant decrease in twin stillbirth rates [9]. Oxytocin and prostaglandins (PG) are commonly used induction methods in twin gestations, despite their increase use, information regarding the outcome of these induced labors is minimal [10,11,12]

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Results

Conclusion